Randomized Trial of Exercise and Nutrition on Chemotherapy Completion and Pathologic Complete Response in Women With Breast Cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis Study

Author(s): Tara Sanft, MD1,2; Maura Harrigan, RD, MS, CSO3; Courtney McGowan, RD, CSO3; Brenda Cartmel, PhD2,3; Michelle Zupa, BS3; Fang-Yong Li, MS3; Leah M. Ferrucci, PhD2,3; Leah Puklin, MPH3; Anlan Cao, BS3; Thai Hien Nguyen, MPH3; Marian L. Neuhouser, PhD4; Dawn L. Hershman, MD5; Karen Basen-Engquist, PhD6; Beth A. Jones, PhD2,3; Tish Knobf, PhD3,7; Anees B. Chagpar, MD, MPH1,2; Andrea Silber, MD1,2; Anna Tanasijevic, MPH8; Jennifer A. Ligibel, MD9; Melinda L. Irwin, PhD, MPH1,2
Source: https://doi.org/10.1200/JCO.23.00871
Maem Hussein MD

Dr. Maen Hussein's Thoughts

There have been studies showing decreased recurrence in women who underwent curative breast surgeries (walking and yoga). This study assesses if it will affect the intensity of chemotherapy delivered. Although it did not affect it, women who underwent the program had better pathologic complete response (pCR), we need more studies to assess role of nutrition and exercise in treating cancer as we develop a wholesome approach to treat our patients, something we may be able to do in our practice.


Successful completion of chemotherapy is critical to improve breast cancer outcomes. Relative dose intensity (RDI), defined as the ratio of chemotherapy delivered to prescribed, is a measure of chemotherapy completion and is associated with cancer mortality. The effect of exercise and eating a healthy diet on RDI is unknown. We conducted a randomized trial of an exercise and nutrition intervention on RDI and pathologic complete response (pCR) in women diagnosed with breast cancer initiating chemotherapy.


One hundred seventy-three women with stage I-III breast cancer were randomly assigned to usual care (UC; n = 86) or a home-based exercise and nutrition intervention with counseling sessions delivered by oncology-certified registered dietitians (n = 87). Chemotherapy dose adjustments and delays and pCR were abstracted from electronic medical records. T-tests and chi-square tests were used to examine the effect of the intervention versus UC on RDI and pCR.


Participants randomly assigned to intervention had greater improvements in exercise and diet quality compared with UC (P < .05). RDI was 92.9% ± 12.1% and 93.6% ± 11.1% for intervention and UC, respectively (P = .69); the proportion of patients in the intervention versus UC who achieved ≥85% RDI was 81% and 85%, respectively (P = .44). The proportion of patients who had at least one dose reduction and/or delay was 38% intervention and 36% UC (P = .80). Among 72 women who received neoadjuvant chemotherapy, women randomly assigned to intervention were more likely to have a pCR than those randomly assigned to UC (53% v 28%; P = .037).


Although a diet and exercise intervention did not affect RDI, the intervention was associated with a higher pCR in patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative and triple-negative breast cancer undergoing neoadjuvant chemotherapy.

Author Affiliations

1Yale University School of Medicine, New Haven, CT; 2Yale Cancer Center, New Haven, CT; 3Yale School of Public Health, New Haven, CT; 4Fred Hutchinson Cancer Research Center, Seattle, WA; 5Columbia University Medical Center, New York, NY; 6The University of Texas MD Anderson Cancer Center, Houston, TX; 7Yale School of Nursing, New Haven, CT; 8Dana-Farber Cancer Institute, Boston, MA; 9Dana-Farber Cancer Institute, Boston, MA

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